Prevalence of hepatitis C virus among fatal drug overdoses in Tennessee: an analysis using 2019-2020 Tennessee State Unintentional Drug Overdose Reporting System Data.

PURPOSE: Given the nature of the co-occurring epidemics of hepatitis C virus (HCV) and fatal stimulant overdose, we sought to assess the prevalence of HCV among opioid and stimulant-positive overdoses. METHODS: We conducted a cross-sectional study to examine the prevalence of HCV among fatal drug overdoses in Tennessee using 2019-2020 data from the State Unintentional Drug Overdose Reporting System. We defined history of HCV using surveillance data and autopsy reports. Descriptive statistics were calculated for circumstances of overdose deaths for different categories of opioid and stimulant positivity on toxicology. RESULTS: Between 2019 and 2020, 3570 unintentional or undetermined drug overdose deaths occurred in Tennessee with an available autopsy. History of HCV was found in 24.6% of deaths. When assessing different involvement between stimulants and opioids, the highest prevalence of HCV was found for deaths where methamphetamine and opioids were present in toxicology (35.4%). Scene evidence of injection drug use occurred more frequently among decedents with a history of HCV (P < .0001). CONCLUSIONS: This analysis while descriptive highlights the importance of linking datasets to enhance infectious disease and drug overdose surveillance. Partnership between communicable disease and drug overdose surveillance teams should continue to identify relationships between disease and drug overdose and strengthen the evidence to tailor crucial treatment and prevention activities.

Validation of OraQuick HCV Rapid Antibody Test in Postmortem Specimens.

INTRODUCTION: The objective of this study is to evaluate the performance of OraQuick HCV Rapid Antibody Test against a "gold-standard", FDA-approved, laboratory-based serum immunoassay (SI) in postmortem blood. To date, OraQuick HCV Rapid Antibody Test has not been evaluated for use in postmortem testing. This OraQuick test is a manually performed, visually interpreted, single use immunoassay for the qualitative detection of antibodies to the hepatitis C virus (HCV). METHODS: Blood was collected from 51 decedents whose deaths were investigated in the jurisdiction of the Knox and Anderson County Medical Examiner's Office (MEO) January 2017 through April 2017. For each consented case, blood was tested using both the OraQuick HCV Rapid Antibody Test and a laboratory-based hepatitis C serum immunoassay ("gold standard" reference assay). Results from the OraQuick HCV Rapid Antibody Test were compared against a laboratory-based hepatitis C serum immunoassay. RESULTS: Using the laboratory-based serum immunoassay (SI) as the "gold standard" for assessing true HCV antibody positivity, and comparing SI against OraQuick rapid test, sensitivity for the OraQuick rapid test was 95.65% and specificity was 96.15% in postmortem blood. DISCUSSION: Our results demonstrate that OraQuick HCV rapid antibody test is reliable for diagnosis of hepatitis C infection in postmortem blood with a relatively short (less than approximately 21.5 hours) postmortem sample acquisition time. The OraQuick in some cases may be superior to traditional, laboratory-based HCV SI due to potential increased viscosity of postmortem blood.

Case Series of Novel Illicit Opioid-Related Deaths.

Novel illicit opioids, such as furanyl fentanyl and U-47700, are being encountered with increasing frequency in street heroin samples and have been confirmed in a series of overdose deaths in Tennessee. In this paper, we report the pathology and toxicology from 11 deaths involving furanyl fentanyl and U-47700. Routine toxicology was performed on postmortem femoral or antemortem hospital blood samples with targeted broad spectrum drug screening using liquid chromatography-time-of-flight mass spectrometry (LC-TOF/MS). Confirmation and quantitation of the opioid agonists U-47700 and furanyl fentanyl was performed by ultra-high-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) using a novel method. Two cases were identified as containing U-47700 in whole blood (189 and 547 ng/mL), and nine cases contained furanyl fentanyl in whole blood, with concentrations ranging from 2.0 - 42.9 ng/mL. In all 11 cases, the manner of death was deemed accident, with drug intoxication being the primary cause of death; one case was complicated by smoke inhalation. All of the decedents were males ranging from 18-62 years, with the median age being 36 years old. The successful identification and confirmation of these novel illicit opioids in this case series relied on the comprehensive investigation and collaboration of scene investigation, forensic pathology, and forensic toxicology.

Fatal Firearm Injuries in Tennessee: A Comparison Study of Tennessee's Two Most Populous Counties 2009-2012.

Firearm injuries are a leading cause of violent death in Tennessee. This study was designed to compare the demographic and epidemiologic features of fatal firearm injuries in Shelby County and Davidson County, Tennessee between 2009 and 2012. We identified 1081 gunshot fatalities for the study period in these two counties. Shelby County had a higher overall, age-adjusted gunshot mortality rate, a higher male age-adjusted gunshot mortality rate, and a higher age-adjusted gunshot homicide rate than Davidson. Age groups 25-34 years and 35-44 years had higher crude mortality rates for gunshot deaths in Shelby County than Davidson County. Both counties had higher age-adjusted gunshot mortality rates for black males than white males, higher homicide rate for black race than white, and higher suicide rate for white race than black. Homicide was the most common manner of death, and handguns were the most common type of firearm used in both counties.

Airborne observations of vegetation and implications for biogenic emission characterization.

Measuring hydrocarbons from aircraft represents one way to infer biogenic emissions at the surface. The focus of this paper is to show that complementary remote sensing information can be provided by optical measurements of a vegetation index, which is readily measured with high temporal coverage using reflectance data. We examine the similarities between the vegetation index and in situ measurements of the chemicals isoprene, methacrolein, and alpha-pinene to estimate whether the temporal behavior of the in situ measurements of these chemicals could be better understood by the addition of the vegetation index. Data were compared for flights conducted around Houston in August and September 2000. The three independent sets of chemical measurements examined correspond reasonably well with the vegetation index curves for the majority of flight days. While low values of the vegetation index always correspond to low values of the in situ chemical measurements, high values of the index correspond to both high and low values of the chemical measurements. In this sense it represents an upper limit when compared with in situ data (assuming the calibration constant is adequately chosen). This result suggests that while the vegetation index cannot represent a purely predictive quantity for the in situ measurements, it represents a complementary measurement that can be useful in understanding comparisons of various in situ observations, particularly when these observations occur with relatively low temporal frequency. In situ isoprene measurements and the vegetation index were also compared to an isoprene emission inventory to provide additional insight on broad issues relating to the use of vegetation indices in emission database development.